Rather HMO . ch the mually -cost punut WIIU Joins a PPO does not need to alter the manner of providing care and continues to treat and bill the patients on a fee-for-service basis. When a patient covered under a PPO plan comes for treatment, the provider treats the patient and bills the PPO. Patients do not need to visit their PCP to obtain a referral to a specialist for more specialized care and they have more control over healthcare choices. PPOs furnish their subscribers with a list of participating providers and healthcare facilities from which they can access in- network healthcare at PPO reduced rates. Rates are quite often lower than those charged to non-PPO patients. Although patients have the option to visit a specialist when they feel the need, they are still required to obtain preauthorization for referrals for more expensive medical therapy such as formulary medi- cation and some medical testing. coup Hers and IPA cia- one ita- ent CRITICAL THINKING APPLICATION 16-3 Henry Hudson called Jodie; he was upset because he received a patient statement balance. He told Jodie that he has full coverage insurance through his employer and did not know why he had a balance. What information can Jodie share with Henry to explain his financial responsibility? Exclusive Provider Organization An EPO combines features of an HMO (e.g., an enrolled group population, PCPs, and an authorization system) and a PPO (e. flexible benefit design and fee-for-service payments). Patients wi EPO coverage will not be covered for services outside the designa network of providers (unless there is an emergency), but may need to obtain a referral for specialized care. EPO plan members not required to choose PCP HMO L blocks in Figure 17-3 highlighted in yellow are information, and the blocks highlighted in blue are information Widuals." w are for the patienis blue are for the insured Blocks 1a, 4, 7, and 11(a-d) Information required for the insured individual incl. health plan ID number, name, address, policy grou date, gender, employer's name (if applicable), the nam ance plan, and whether the insured has another health be dual includes the persons s policy group number, bih the name of the insu- er health benefit plan. Blocks 2, 3, 5, 6, and 10 a-c Required information for the patient includes the person's na birth date, gender, address, relationship to the insured, patient statul and whether the patient's condition is related to his or her job, an automobile accident, or some other accident. CRITICAL THINKING APPLICATION 17-2 Ann is preparing an insurance claim to bill to Blue Cross. She notes that the patient is the dependent of the insured, so she reviews the patient registrar tion intake form and finds that the date of birth for the insured is not present. Can Ann accurately complete the CMS-1500? Block 9 Block 9 is for recording information about any secondary plan that may be applicable. The data required include th sured person's name, policy or group number, birth date, gee employer (if applicable), and the name of the other inst tany secondary insurance ed include the other in date, gender, and other insurance plan 1 1 10 0 C Jou, a Lutomobile accident, or some other accident. CRITICAL THINKING APPLICATION 17-2 Ann is preparing an insurance claim to bill to Blue Cross. She notes that the patient is the dependent of the insured, so she reviews the patient registro tion intake form and finds that the date of birth for the insured is not present. Can Ann accurately complete the CMS-1500? Block 9 eferrals for more expensive medical therapy such as formulary medi- ation and some medical testing. CRITICAL THINKING APPLICATION 16-3 Henry Hudson called Jodie; he was upset because he received a patient statement balance. He told Jodie that he has full coverage insurance through his employer and did not know why he had a balance. What information can Jodie share with Henry to explain his financial responsibility? Rather HMO . ch the mually -cost punut WIIU Joins a PPO does not need to alter the manner of providing care and continues to treat and bill the patients on a fee-for-service basis. When a patient covered under a PPO plan comes for treatment, the provider treats the patient and bills the PPO. Patients do not need to visit their PCP to obtain a referral to a specialist for more specialized care and they have more control over healthcare choices. PPOs furnish their subscribers with a list of participating providers and healthcare facilities from which they can access in- network healthcare at PPO reduced rates. Rates are quite often lower than those charged to non-PPO patients. Although patients have the option to visit a specialist when they feel the need, they are still required to obtain preauthorization for referrals for more expensive medical therapy such as formulary medi- cation and some medical testing. coup Hers and IPA cia- one ita- ent CRITICAL THINKING APPLICATION 16-3 Henry Hudson called Jodie; he was upset because he received a patient statement balance. He told Jodie that he has full coverage insurance through his employer and did not know why he had a balance. What information can Jodie share with Henry to explain his financial responsibility? Exclusive Provider Organization An EPO combines features of an HMO (e.g., an enrolled group population, PCPs, and an authorization system) and a PPO (e. flexible benefit design and fee-for-service payments). Patients wi EPO coverage will not be covered for services outside the designa network of providers (unless there is an emergency), but may need to obtain a referral for specialized care. EPO plan members not required to choose PCP HMO L blocks in Figure 17-3 highlighted in yellow are information, and the blocks highlighted in blue are information Widuals." w are for the patienis blue are for the insured Blocks 1a, 4, 7, and 11(a-d) Information required for the insured individual incl. health plan ID number, name, address, policy grou date, gender, employer's name (if applicable), the nam ance plan, and whether the insured has another health be dual includes the persons s policy group number, bih the name of the insu- er health benefit plan. Blocks 2, 3, 5, 6, and 10 a-c Required information for the patient includes the person's na birth date, gender, address, relationship to the insured, patient statul and whether the patient's condition is related to his or her job, an automobile accident, or some other accident. CRITICAL THINKING APPLICATION 17-2 Ann is preparing an insurance claim to bill to Blue Cross. She notes that the patient is the dependent of the insured, so she reviews the patient registrar tion intake form and finds that the date of birth for the insured is not present. Can Ann accurately complete the CMS-1500? Block 9 Block 9 is for recording information about any secondary plan that may be applicable. The data required include th sured person's name, policy or group number, birth date, gee employer (if applicable), and the name of the other inst tany secondary insurance ed include the other in date, gender, and other insurance plan 1 1 10 0 C Jou, a Lutomobile accident, or some other accident. CRITICAL THINKING APPLICATION 17-2 Ann is preparing an insurance claim to bill to Blue Cross. She notes that the patient is the dependent of the insured, so she reviews the patient registro tion intake form and finds that the date of birth for the insured is not present. Can Ann accurately complete the CMS-1500? Block 9 eferrals for more expensive medical therapy such as formulary medi- ation and some medical testing. CRITICAL THINKING APPLICATION 16-3 Henry Hudson called Jodie; he was upset because he received a patient statement balance. He told Jodie that he has full coverage insurance through his employer and did not know why he had a balance. What information can Jodie share with Henry to explain his financial responsibility